Improvements in continuum of care CoC utilization are needed to address inadequate reductions in neonatal and infant mortality in India and elsewhere. This study examines the effect of Ananya, a health system training and community outreach intervention, on reproductive, maternal and newborn health continuum of care RMNH CoC utilization in Bihar, India, and explores whether that effect is moderated by gender equity factors child marriage, restricted mobility and low decision-making control.

Participants reported low RMNH CoC co-coverage at baseline on average 3.2 and 3.0 of the 9 RMNH services-behaviors for Ananya and control groups, respectively. The Ananya group showed a significantly greater increase in RMNH CoC co-coverage .41 services compared with the control group over time p<0.001, with the primary drivers being increases in clean cord care, skin-to-skin care and postpartum contraceptive use. Gender equity interaction analyses revealed diminished intervention effects on antenatal care, skilled birth attendance and exclusive breastfeeding for women married as minors.

Conclusion

Ananya improved RMNH CoC co-coverage among these recent mothers, largely through positive health behavior changes. Child marriage attenuated Ananya’s impact on utilization of key health services and behaviors. Supporting the health system with training and community outreach can be beneficial to RMNH CoC utilization; additional support is needed to adequately address the unique issues faced by women married as minors.